BENEFICIARY DESIGNATIONS

1

Is this a new account?* This field is required.

It is a new account

Not a new account

2

FULL NAME* This field is required.

3

EMAIL* This field is required.

example@example.com

4

IRA CLUB ACCOUNT NUMBER (IF AVAILABLE)

5

TYPE* This field is required.1) Primary: If the account owner passes away, the assets will be inherited by any living and willing primary beneficiaries. 2) Contingent: If all primary beneficiaries predecease the account owner or are not willing to accept the assets, the next in line to receive the assets is the contingent beneficiary.

PRIMARY

CONTINGENT

6

BENEFICIARY - INDIVIDUAL NAME OR ENTITY NAME* This field is required.

7

SSN/TIN

8

DOB

9

RELATIONSHIP

10

PERCENTAGE* This field is required.

12

RELATIONSHIP* This field is required.

PRIMARY

CONTINGENT

13

BENEFICIARY - INDIVIDUAL NAME OR ENTITY NAME* This field is required.

14

SSN/TIN

15

DOB

16

RELATIONSHIP

17

PERCENTAGE* This field is required.

18

TYPE* This field is required.

PRIMARY

CONTINGENT

19

BENEFICIARY - INDIVIDUAL NAME OR ENTITY NAME* This field is required.

20

SSN/TIN

21

DOB

22

RELATIONSHIP

23

PERCENTAGE* This field is required.

24

TYPE* This field is required.

PRIMARY

CONTINGENT

25

BENEFICIARY - INDIVIDUAL NAME OR ENTITY NAME* This field is required.

26

SSN/TIN

27

DOB

28

RELATIONSHIP

29

PERCENTAGE* This field is required.

30

TYPE* This field is required.

PRIMARY

CONTINGENT

31

BENEFICIARY - INDIVIDUAL NAME OR ENTITY NAME* This field is required.

32

SSN/TIN

33

DOB

34

RELATIONSHIP

35

PERCENTAGE* This field is required.

36

TYPE* This field is required.

PRIMARY

CONTINGENT

37

BENEFICIARY - INDIVIDUAL NAME OR ENTITY NAME* This field is required.

38

SSN/TIN* This field is required.

39

DOB* This field is required.

40

RELATIONSHIP

41

PERCENTAGE* This field is required.

42

Terms and Conditions* This field is required.

43

Signature* This field is required.

Clear

44

Date Signed* This field is required.

Date